“It can be dangerous when they are transporting persons to medical care facilities while they are too tired to drive.”

John Violanti, research professor of epidemiology and environmental health

University at Buffalo

BUFFALO, N.Y. — University at Buffalo researchers played a
key role in the development of new guidelines released in January
for managing fatigue in emergency medical services (EMS)
personnel.

John Violanti, a former New York State Police trooper who
studies police stress and fatigue among public safety workers,
helped draft the guidelines along with researchers from the
University of Pittsburgh Medical Center.

Violanti, PhD, research professor of epidemiology and
environmental health in UB’s School of Public Health and
Health Professions, is a co-author on the paper,
“Evidence-based guidelines for fatigue risk management in
Emergency Medical Services,” published in a special issue of
the journal Prehospital
Emergency Care.

In addition, David Hostler and Jennifer Temple were the lead
authors on a supporting review on caffeine use and fatigue in shift
workers — a review that found a lack of research on caffeine
and its effects on EMS shift workers in particular. Theirs is one
of six supporting reviews published in the special issue.

Hostler, PhD, is chair of exercise and nutrition sciences at UB.
He has extensive experience in EMS research and was asked by P.
Daniel Patterson, the principal investigator and an assistant
professor of emergency medicine at the University of Pittsburgh, to
participate in the project.

Temple,
PhD, is an associate professor of exercise and nutrition sciences
and also serves as director of the Nutrition and Health Research
Laboratory at UB. She is a nationally recognized expert on caffeine
use.

Five guidelines for reducing fatigue

The problem of overly tired EMS workers is widespread, and
it’s problematic for a variety of reasons. EMS personnel who
are fatigued are more likely to get injured on the job and make
mistakes when caring for patients, researchers say.

EMS organization managers aren’t properly equipped to
address workplace fatigue, in part because until now there
haven’t been any guidelines for managing fatigue risk in the
EMS setting, according to researchers.

Based on a review of evidence published between 1980 and 2016,
the panel created five recommendations for fatigue risk management
in EMS operations. Their guidelines range from the obvious —
that EMS personnel should work shifts shorter than 24 hours in
duration — to the more novel, such as allowing EMS workers to
nap while on duty to mitigate fatigue.

In addition, the panel recommends using fatigue/sleepiness
survey instruments to measure and monitor fatigue in EMS workers.
They also suggest that emergency responders have access to caffeine
to combat fatigue.

The guidelines also recommend training and education in
mitigating fatigue and fatigue-related risks. For example,
education in sleep health may help EMS workers identify undiagnosed
sleep disorders, such as obstructive sleep apnea, which can affect
their performance while on duty. Back-to-back shifts and overtime
are common.

In addition, half of EMS clinicians report mental and physical
fatigue while at work, as well as poor sleep quality, according to
Violanti.

“It can be dangerous when they are transporting persons to
medical care facilities while they are too tired to drive,”
says Violanti. “Additionally, their own physical health is at
risk if they are not getting the proper sleep. We know that poor
sleep and shift work are associated with heart disease and
diabetes, for example.”

Caffeine use and emergency responders

In their supporting
review, published along with the new guidelines, Hostler,
Temple and colleagues conducted a meta-analysis of nearly 1,400
studies that focus on caffeine as a countermeasure for fatigue in
shift workers.

This included worker groups, such as pilots or drivers, whose
jobs require intense concentration and attention to detail per
shift, and which can have serious, possibly deadly, consequences
when workers are inattentive or careless due to being overly
tired.

In particular, researchers sought to identify studies that
addressed patient safety and EMS personnel safety through
interventions using caffeine as a countermeasure to fatigue and
sleepiness.

“There are no studies that investigate caffeine use and
its effects on EMS workers or on patient safety,” they
write.

“The lack of direct evidence for caffeine use in EMS
workers makes the case that we need studies in this area to
identify proper dose and timing to improve both patient safety and
EMS workers health and safety,” says Hostler.

They did find a handful of studies indicating that caffeine can
help combat fatigue and improve performance in shift workers. For
example, studies showed that caffeine use can lead to faster
reaction time while lessening a slowdown in reaction time at the
end of a shift.

However, EMS workers were not a represented group in these
studies; one study assessed personnel safety by simulating a night
mission in pilots, while another employed a driving simulator.

Previous studies also showed that caffeine reduces sleep
duration and quality, which could have serious implications for
emergency personnel and patients alike, Hostler and Temple note,
adding that additional studies are needed in order to better
understand how caffeine affects the safety of both EMS personnel
and patients.